Back Pain Surgery
Operative treatments continued...
Regardless of how spinal fusion is performed, the fused area of the spine becomes immobilized.
For vertebral osteoporotic fractures (used only if standard care, rest, corsets/braces, analgesics fail):
Vertebroplasty: When back pain is caused by a compression fracture of a vertebra due to osteoporosis or trauma, doctors may make a small incision in the skin over the affected area and inject a cement-like mixture called polymethyacrylate into the fractured vertebra to relieve pain and stabilize the spine. The procedure is generally performed on an outpatient basis under a mild anesthetic.
Kyphoplasty: Much like vertebroplasty, kyphoplasty is used to relieve pain and stabilize the spine following fractures due to osteoporosis. Kyphoplasty is a two-step process. In the first step, the doctor inserts a balloon device to help restore the height and shape of the spine. In the second step, he or she injects polymethyacrylate to repair the fractured vertebra. The procedure is done under anesthesia, and in some cases it is performed on an outpatient basis.
For Discogenic Low Back Pain (Degenerative Disc Disease)
Intradiscal electrothermal therapy (IDT): One of the newest and least invasive therapies for low back pain involves inserting a heating wire through a small incision in the back and into a disc. An electrical current is then passed through the wire to strengthen the collagen fibers that hold the disc together. The procedure is done on an outpatient basis, often under local anesthesia. The usefulness of IDT is debatable.
Spinal fusion: When the degenerated disc is painful, the surgeon may recommend removing it and fusing the disc to help with the pain. This fusion can be done through the abdomen, a procedure known as anterior lumbar interbody fusion, or through the back, called posterior fusion. Theoretically, fusion surgery should eliminate the source of pain; the procedure is successful in about 60 to 70 percent of cases. Fusion for low back pain or any spinal surgeries should only be done as a last resort, and the patient should be fully informed of risks.
Disc replacement: When a disc is herniated, one alternative to a discectomy - in which the disc is simply removed - is removing it and replacing it with a synthetic disc. Replacing the damaged one with an artificial one restores disc height and movement between the vertebrae. Artificial discs come in several designs.
Although doctors in Europe had performed disc replacement for more than a decade, the procedure had been experimental in the United States until the Food and Drug Administration approved the Charite artificial disc for use.